title: United States women receive more curative treatment for hepatocellular carcinoma than men.
abstract: BACKGROUND
  Previous database studies have found gender disparities favoring men in rates of liver transplantation, which resolve in cohorts examining only patients with hepatocellular carcinoma (HCC).
  
  
  OBJECTIVE
  Our study aims to use two large, multicenter United States (US) databases to assess for gender disparity in HCC treatment regardless of transplant listing status.
  
  
  METHODS
  We performed a retrospective database analysis of inpatient admission data from the University Health Consortium (UHC) and the Nationwide Inpatient Sample (NIS), over a 9- and 10-year period, respectively. Adults with a primary discharge diagnosis of HCC, identified using the International Classification of Diseases 9th Edition (ICD-9) code, were included. Series of univariate and multivariate analyses were performed to examine gender disparities in metastasis, liver decompensation, treatment type, and inpatient mortality after controlling for other possible predictors.
  
  
  RESULTS
  We included 26,054 discharges from the NIS database and 25,671 patients from the UHC database in the analysis. Women with HCC appear to present less often with decompensated liver disease (OR = 0.79, p < 0.001). Furthermore they are more likely to receive invasive HCC treatment, with significantly higher rates of resection across race and diagnoses (OR = 1.34 and 1.44, p < 0.001). Univariate analyses show that US women have lower unadjusted rates of transplant; however, the disparity resolves after controlling for other clinical and demographic factors.
  
  
  CONCLUSIONS
  US women more often receive invasive treatment for HCC (especially resection) than US men with no observed disparity in transplantation rates when adjusted for pre-treatment variables.
authors.affiliation: Department of Medicine, Section of Gastroenterology and Hepatology, Tulane University Health Sciences Center, New Orleans, LA, USA, stephanie.cauble@gmail.com.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Cauble
authors.forename: Ali
authors.initials: A
authors.lastname: Abbas
authors.forename: Luis
authors.initials: L
authors.lastname: Balart
authors.forename: Lydia
authors.initials: L
authors.lastname: Bazzano
authors.forename: Sabeen
authors.initials: S
authors.lastname: Medvedev
authors.forename: Nathan
authors.initials: N
authors.lastname: Shores
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008099:Liver / Q000503:physiopathology; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D014850:Waiting Lists